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Predictors of time to recovery and non-response during outpatient treatment of severe acute malnutrition

BACKGROUND: Every year, over 4 million children are treated for severe acute malnutrition with varying program performance. This study sought to explore the predictors of time to recovery from and non-response to outpatient treatment of SAM. METHODS: Children with weight-for-height z-score (WHZ) <...

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Autores principales: Kangas, Suvi T., Salpéteur, Cécile, Nikièma, Victor, Ritz, Christian, Friis, Henrik, Briend, André, Kaestel, Pernille
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9154090/
https://www.ncbi.nlm.nih.gov/pubmed/35639683
http://dx.doi.org/10.1371/journal.pone.0267538
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author Kangas, Suvi T.
Salpéteur, Cécile
Nikièma, Victor
Ritz, Christian
Friis, Henrik
Briend, André
Kaestel, Pernille
author_facet Kangas, Suvi T.
Salpéteur, Cécile
Nikièma, Victor
Ritz, Christian
Friis, Henrik
Briend, André
Kaestel, Pernille
author_sort Kangas, Suvi T.
collection PubMed
description BACKGROUND: Every year, over 4 million children are treated for severe acute malnutrition with varying program performance. This study sought to explore the predictors of time to recovery from and non-response to outpatient treatment of SAM. METHODS: Children with weight-for-height z-score (WHZ) <-3 and/or mid-upper arm circumference (MUAC) <115 mm, without medical complications were enrolled in a trial (called MANGO) from outpatient clinics in Burkina Faso. Treatment included a weekly ration of ready-to-use therapeutic foods. Recovery was declared with WHZ ≥-2 and/or MUAC ≥125 mm, for two weeks without illness. Children not recovered by 16 weeks were considered as non-response to treatment. Predictors studied included admission characteristics, morbidity and compliance during treatment and household characteristics. Cox proportional hazard models were fitted and restricted mean time to recovery calculated. Logistic regression was used to analyse non-response to treatment. RESULTS: Fifty-five percent of children recovered and mean time to recovery was eight weeks while 13% ended as non-response to treatment. Independent predictors of longer time to recovery or non-response included low age, being admitted with WHZ <-3, no illness nor anaemia at admission, illness episodes during treatment, skipped or missed visits, low maternal age and not practising open defecation. Eighty-four percent of children had at least one and 59% at least two illness episodes during treatment. This increased treatment duration by 1 to 4 weeks. Thirty-five percent of children missed at least one treatment visit. One missed visit predicted 3 weeks longer and two or more missed visits 5 weeks longer treatment duration. CONCLUSIONS: Both longer time to recovery and higher non-response to treatment seem most strongly associated with illness episodes and missed visits during treatment. This indicates that prevention of illnesses would be key to shortening the treatment duration and that there is a need to seek ways to facilitate adherence.
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spelling pubmed-91540902022-06-01 Predictors of time to recovery and non-response during outpatient treatment of severe acute malnutrition Kangas, Suvi T. Salpéteur, Cécile Nikièma, Victor Ritz, Christian Friis, Henrik Briend, André Kaestel, Pernille PLoS One Research Article BACKGROUND: Every year, over 4 million children are treated for severe acute malnutrition with varying program performance. This study sought to explore the predictors of time to recovery from and non-response to outpatient treatment of SAM. METHODS: Children with weight-for-height z-score (WHZ) <-3 and/or mid-upper arm circumference (MUAC) <115 mm, without medical complications were enrolled in a trial (called MANGO) from outpatient clinics in Burkina Faso. Treatment included a weekly ration of ready-to-use therapeutic foods. Recovery was declared with WHZ ≥-2 and/or MUAC ≥125 mm, for two weeks without illness. Children not recovered by 16 weeks were considered as non-response to treatment. Predictors studied included admission characteristics, morbidity and compliance during treatment and household characteristics. Cox proportional hazard models were fitted and restricted mean time to recovery calculated. Logistic regression was used to analyse non-response to treatment. RESULTS: Fifty-five percent of children recovered and mean time to recovery was eight weeks while 13% ended as non-response to treatment. Independent predictors of longer time to recovery or non-response included low age, being admitted with WHZ <-3, no illness nor anaemia at admission, illness episodes during treatment, skipped or missed visits, low maternal age and not practising open defecation. Eighty-four percent of children had at least one and 59% at least two illness episodes during treatment. This increased treatment duration by 1 to 4 weeks. Thirty-five percent of children missed at least one treatment visit. One missed visit predicted 3 weeks longer and two or more missed visits 5 weeks longer treatment duration. CONCLUSIONS: Both longer time to recovery and higher non-response to treatment seem most strongly associated with illness episodes and missed visits during treatment. This indicates that prevention of illnesses would be key to shortening the treatment duration and that there is a need to seek ways to facilitate adherence. Public Library of Science 2022-05-31 /pmc/articles/PMC9154090/ /pubmed/35639683 http://dx.doi.org/10.1371/journal.pone.0267538 Text en © 2022 Kangas et al https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Kangas, Suvi T.
Salpéteur, Cécile
Nikièma, Victor
Ritz, Christian
Friis, Henrik
Briend, André
Kaestel, Pernille
Predictors of time to recovery and non-response during outpatient treatment of severe acute malnutrition
title Predictors of time to recovery and non-response during outpatient treatment of severe acute malnutrition
title_full Predictors of time to recovery and non-response during outpatient treatment of severe acute malnutrition
title_fullStr Predictors of time to recovery and non-response during outpatient treatment of severe acute malnutrition
title_full_unstemmed Predictors of time to recovery and non-response during outpatient treatment of severe acute malnutrition
title_short Predictors of time to recovery and non-response during outpatient treatment of severe acute malnutrition
title_sort predictors of time to recovery and non-response during outpatient treatment of severe acute malnutrition
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9154090/
https://www.ncbi.nlm.nih.gov/pubmed/35639683
http://dx.doi.org/10.1371/journal.pone.0267538
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